<div class="form_details">
	<div class="space30"></div>
	<!--form_container starts-->
	<div class="form_container">
		<h4 style="background-color:#FF8200 !important;color:#ffffff !important;">
			<?php if(isset($form_detail[0]['event_name'])){ echo "Nomination for  ".$form_detail[0]['event_name'].' - ';} ?>
			<?php if(isset($form_detail[0]['award_name'])){ echo $form_detail[0]['award_name'];} ?>
		</h4>
	</div>
	<!--form_container starts-->
	<div class="space10"></div>
	<!--form_container starts-->
	
	<!------------------------------------------Personal Info------------------------------->
	<?php echo form_open_multipart(BASE_URL . '/user/add_user_nomination', array('id' => 'user_nomination_dis_form', 'method' => 'post')); ?>
	<?php if(isset($form_list_dis) && !empty($form_list_dis)){
			foreach($form_list_dis as $key => $temp)
			{
				$personal[$key]['id']=$temp['event_nomination_form_id'];
				$personal[$key]['name']=$temp['master_nomination_form_name'];
				$personal[$key]['input_type']=$temp['master_nomination_form_type'];
				$personal[$key]['label']=$temp['event_nomination_form_label'];
				$personal[$key]['man']=$temp['event_nomination_form_mandatory'];
				$personal[$key]['type_extra']=$temp['master_nomination_form_extra'];
			}
	?>
	<div class="form_container">
		<h4>Disclosure Notice</h4>
		<?php
			for($i=0;$i<=count($personal);$i++)
			{
		?>
			<!--row starts-->
			<div class="row1">
				<?php if(isset($personal[$i]['label'])){ ?>
				<div class="form-group col-sm-6" style="margin-bottom:10px;">
					<label><?php echo $personal[$i]['label']; ?> <?php if($personal[$i]['man'] == 'Yes') echo "<span class='asterisk'>*</span>"; ?></label>
					<div class="error error_msg" id="err-<?php echo $personal[$i]['name']; ?>"></div>
				</div>
				<?php } ?>
				<?php if(isset($personal[$i]['label']) && $personal[$i]['label'] == 'Have you previously worked with the nominee?'){ ?>
				<div class="form-inline col-sm-6">
					<input type="radio" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_1" name="<?php echo $personal[$i]['name']; ?>" <?php if($personal[$i]['man'] == 'Yes') echo 'required'; ?> value="Yes">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_1">Yes</label>
					&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
					<input type="radio" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_2" name="<?php echo $personal[$i]['name']; ?>" value="No">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_2">No</label>
				</div>
				<?php } ?>
				<?php if(isset($personal[$i]['label']) && $personal[$i]['label'] == 'If Yes, in what capacity?'){ ?>
				<div class="clearfix"></div>
				<div class="form-inline col-sm-6" style="width:100%;margin:-10px 0 15px 0;">
					<input type="checkbox" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_1" name="<?php echo $personal[$i]['name']; ?>[]" <?php if($personal[$i]['man'] == 'Yes') echo 'required'; ?> value="As Researcher or Academic Advisor">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_1" style="font-weight:normal;">As Researcher or Academic Advisor</label>
					&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
					<input type="checkbox" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_2" name="<?php echo $personal[$i]['name']; ?>[]" value="Professional College">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_2" style="font-weight:normal;">Professional College</label>
					&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
					<input type="checkbox" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_3" name="<?php echo $personal[$i]['name']; ?>[]" value="Professor / Advisor">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_3" style="font-weight:normal;">Professor / Advisor</label>
					&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
					<input type="checkbox" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_4" name="<?php echo $personal[$i]['name']; ?>[]" value="Others">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_4" style="font-weight:normal;">Others</label>
				</div>
				<?php }?>
				<?php if(isset($personal[$i]['label']) && $personal[$i]['label'] == 'Is this nomination from an'){ ?>
				<div class="form-inline col-sm-6">
					<input type="radio" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_1" name="<?php echo $personal[$i]['name']; ?>" <?php if($personal[$i]['man'] == 'Yes') echo 'required'; ?> value="Individual">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_1">Individual</label>
					&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
					<input type="radio" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_2" name="<?php echo $personal[$i]['name']; ?>" value="Institution">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_2">Institution</label>
				</div>
				<?php } ?>
				<?php if(isset($personal[$i]['label']) && $personal[$i]['label'] == 'Information to Nominee'){ ?>
				<div class="clearfix"></div>
				<div class="form-inline col-sm-6" style="width:100%;margin:-10px 0 15px 0;">
					<input type="radio" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_1" name="<?php echo $personal[$i]['name']; ?>" <?php if($personal[$i]['man'] == 'Yes') echo 'required'; ?> value="I have contacted">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_1" style="font-weight:normal;">I have contacted and informed the nominee</label>
					&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
					<input type="radio" class="form-control white" id="<?php echo $personal[$i]['name']; ?>_2" name="<?php echo $personal[$i]['name']; ?>" value="Please contact">&nbsp;&nbsp; <label for="<?php echo $personal[$i]['name']; ?>_2" style="font-weight:normal;">Please contact the nominee on my behalf</label>
				</div>
				<?php } ?>
				<div class="clearfix"></div>
			</div>
			<!--raw closed-->
		<?php }?>
	</div>
	<!--form_container starts-->
	<div class="space30"></div>
	<!--form_container starts-->
	<input type="hidden" name="app_award_id" value="<?php if(isset($form_detail[0]['award_id'])){ echo $form_detail[0]['award_id'];} ?>" />
	<input type="hidden" name="app_event_id" value="<?php if(isset($form_detail[0]['event_id'])){ echo $form_detail[0]['event_id'];} ?>" />
	<input type="hidden" name="app_type" value="disclosure" />
	<button type="button" class="btn btn-primary" id="applicant_form_submit_disclosure">
		Submit
	</button>
	<?php }?>
	<?php echo form_close(); ?>
</div>